Canadian men get prostate cancer more than any other cancer, and one in nine men are diagnosed with it during their life. Most cases are discovered in their early stages, which is part of the reason there’s a 93% probability of surviving prostate cancer in Canada. Despite this, population-wide prostate-specific antigen (PSA) screening for prostate cancer isn’t recommended. That doesn’t mean PSA screening is wrong for you, however. If you’re wondering whether you should get your prostate tested, or simply feel confused about it, you’re not alone. Here’s how to know if you should go for prostate screening.
What is the prostate and where can I find it?
Your prostate is a gland that sits below your bladder and in front of your rectum. It makes a protein called prostate-specific antigen (PSA) that makes up part of your seminal fluid and is also found in your blood. Your prostate is typically the size of a walnut, but it can sometimes swell to the proportions of a tennis ball.
What is PSA testing?
A PSA test is a simple blood test that measures the level of prostate-specific antigen (PSA) in your blood. All prostates make PSA, but cancerous prostate tissue generally produces more of it than healthy tissue does. Since PSA circulates in your bloodstream, labs measure it in nanograms per millilitre of blood (ng/mL). PSA levels are age-dependent — in older men, a level higher than 4 ng/mL can be normal, e.g., 6.5 ng/mL in 70-year-olds. Higher levels of PSA might indicate an abnormality, though not necessarily cancer. The higher your PSA levels, the more likely your healthcare practitioner is to refer you to a urologist for an MRI or biopsy to investigate further.
What are the symptoms of prostate cancer?
Personal risk factors aren’t the only reason for prostate screening. Prostate cancer symptoms aren’t specific and can apply to other conditions as well. Most men with prostate cancer have no symptoms at all. Still, any of the following require medical follow-up:
- Pain or burning during urination
- Painful ejaculation
- Blood in your semen or urine
- Difficulty getting an erection
- Frequent, strong, and/or sudden urge to urinate
- Interrupted urine flow, dribbling, or feeling like you have to push to urinate
- Feeling like your bladder isn’t fully empty
- Pain, fatigue, and weight loss
Why is PSA testing controversial?
The benefits of prostate testing can be significant, but it’s considered controversial for a couple of reasons. While high PSA levels are a possible indication of prostate cancer, they can also be caused by other things. About one in four abnormal PSA tests are a result of cancer, which means that three-quarters aren’t. Getting an abnormal result can cause stress from thinking you might have cancer when you don’t. Beyond that, it may also spur you to request more invasive procedures — like a prostate biopsy.
Not only can a PSA test scare you into thinking you have cancer when you don’t, but it’s also possible that screening might not detect cancerous cells. Not all cancers produce high levels of PSA. That makes it possible to have prostate cancer but show normal PSA levels, giving you a false negative.
Prostate cancer doesn’t always need treatment
Even if your investigation turns up cancer, it might not require treatment. Some men have aggressive forms of prostate cancer which metastasize (spread) quickly. In these cases, early diagnosis and treatment are key to averting severe illness and sometimes death. Data suggests, however, that as many as 67% of men with a prostate cancer diagnosis have clinically insignificant levels of disease. It sounds abnormal to call cancer clinically insignificant, but these cancers are typically slow-growing, don’t spread beyond the prostate, and are unlikely to shorten your life.
Many men with low-risk prostate cancer choose to treat it. Treatment usually means radiation, chemotherapy, or surgery, which may cause side effects like erectile dysfunction and bowel and urinary issues — sometimes resulting in more complications than the actual cancer. Active surveillance through more frequent PSA testing may be a better choice for those with low-risk prostate cancer.
Who needs PSA testing?
Not everyone needs prostate testing, but that doesn’t mean screening is wrong for you. A family history of prostate cancer puts you at a higher risk of developing it. A number of other factors, such as a BRCA gene mutation, obesity, diet and occupational exposure to certain substances play a role as well. Research also shows that Black men have higher rates of prostate cancer, though researchers aren’t clear why.
PSA testing may also be valuable even if you’re not at higher risk of developing prostate cancer. Since most prostate cancers develop after age 50, offering PSA testing to men in their 40s can help to establish a baseline for future prostate cancer risk. These tests can provide a benchmark, alerting you to rising PSA levels as you age that may signal cancer or other issues. At this time, however, screening isn’t supported by the Canadian Urological Association until at least age 45, which means that it may not be covered by your local healthcare plan. If you have risk factors for prostate cancer or want to learn more about your baseline PSA levels, speak to your healthcare provider about your PSA testing options.
Establishing a prostate cancer diagnosis early can offer a higher chance of a cure if your cancer requires treatment. Without proper guidance from a medical professional, however, testing your PSA levels can cause stress and confusion. Talk to our oncology navigation team if you have further questions about prostate cancer screening or have been given a prostate cancer diagnosis.
The information presented here is for educational purposes and is not meant to replace the advice from your medical professional.